Tattoo Inks and Cancer: Navigating Regulatory Questions

Are we any closer to a regulatory position?

Scientists continue to raise alarm over the possibility that some inks used for tattoos contain cancer-causing chemicals.

In this report, we present the outcome of an interview with Professor Ian Olver AM, Director of Sansom Institute of Health Research, University of South Australia and former CEO of the Cancer Council of Australia.

We also present the latest information published on the Cancer Council website and information on APAN’s continued pursuit of a more formal regulatory position.

Who is Professor Ian Olver?

• Professor Ian Olver is a cancer researcher, bioethicist and medical oncologist, with senior posts in Australia and abroad.

• His expertise is widely sought across the sector and by the government. He is a member of the Advisory Council for Cancer Australia (the Federal Government’s cancer control agency) and the Board of the National Breast and Ovarian Cancer Centre, several grants and ethics committees.

He holds several honorary academic and clinical posts. Professor Olver’s main research interests are new anti-cancer drug studies, symptom control, bioethics and psycho-oncology. He has authored more than 200 journal articles, 19 book chapters and two books, as well as co-editing two books.

Research results you need to know

• Extensive research has confirmed the concern that some pigments come as small particles (nanoparticles) that could easily enter the bloodstream and accumulate in organs such as the spleen and kidneys.
• These organs filter impurities and their failure may ultimately increase the risk of cancer. But should we be worried? Let’s look at the evidence.

Tattoo Ink Chemicals

There is no doubt some of the chemicals in tattoo ink have been associated with cancer.

• The red colours can contain mercury, which causes cancer in rats and growth problems in babies of exposed women. However, no definite evidence exists of linking mercury exposure in humans to cancer.

• The greens and blues contain cobalt which has been found to cause cancers in animals – however, the risk in humans needs to be explored further.

• One component of black ink, benzo(a)pyrene, is a potent cancer-causing chemical and has been linked to skin cancers in petroleum workers.

• Jorgen Serup, Professor of Dermatology from Copenhagen University, reported that 13 of 21 tattoo inks commonly used in Europe contained cancer-causing chemicals.

• Even tattoo ink manufacturers admit that 5% of their products contain these types of chemicals.

How much is too much?

• Even if these inks do contain components that have the potential to cause cancer, we still don’t know whether people who have tattoos are exposed to enough of them to cause cancer.

• It may be that huge doses are needed, well beyond the exposure from tattooing, or perhaps only small doses are required over time.

• This is an important fact that is currently continuing to be investigated to confirm the exact link between tattooing and cancer.

A recent question was presented to the Cancer Council of Australia “Does tattoo ink give you cancer?”  

The response

We are not aware of a reported cancer case directly attributable to tattooing.

• However, evidence does show that some tattoo inks contain carcinogens (cancer-causing substances) chemicals that have been classified as known or possible carcinogens by the WHO’s International Agency for Research on Cancer.

• Subsequently, a 2016 report from the Australian Government’s Department of Health, National Industrial Chemical’s Notification and Assessment Scheme (NICNAS) now transitioned into the Australian Industrial Chemicals Introduction Scheme (AICIS) investigated the composition of 49 tattoo inks and found a mismatch between content and labelling, as well as concern about some components.

• Polycyclic Aromatic Hydrocarbons (PAHs), a group of chemicals that are known carcinogens, were found in a fifth of the samples tested and in 83% of the black inks tested by NICNAS. Other hazardous components included barium, copper, mercury, amines and various colourants.

• To achieve the permanent effect, tattoo ink is injected into the dermis – the deeper layer of the skin – and stays in the skin for a lifetime.

• Over time, macrophages take up pigment and may transport it into the lymphatic system and lymph nodes. This means other tissues in the body can be exposed to potentially carcinogenic materials in the tattoo ink. 

A recent review found that the number of skin cancers in tattooed skin was low, and therefore seems coincidental, however further studies identified several carcinogens that have been found in tattoo inks that have been associated with cancers elsewhere in the body, such as the liver or bladder.

Precautionary measures

• The report suggested that if a tattoo covers or surrounds a mole you might not see changes that could indicate skin cancer.
• The tattoo pigments in your skin may make it difficult for a doctor to accurately detect cancer, delaying the diagnosis of melanoma or skin cancer.

The advice given was, “If you are concerned, don’t get tattooed”. Or if you choose to get tattooed, ask if the inks being used comply with the European standard known as ResAP(2008)1, which sets out the requirements and criteria for the safety of tattoos.

Our Position

APAN always places a high priority on the safety of the profession, its practitioners and the public. 

• We are therefore the only industry association within Australia that is continuing to pursue the regulatory process for tattoo inks and pigments. 
• Our position is strictly non-partisan with safety as our main and only focus.

What are we doing to help?

• Currently, the matter has been designated to the TGA
• We are actively pursuing the continuation of this process, which has now shifted from a Queensland Health undertaking to the jurisdiction of a federal body
• We believe this is a wise move, as any regulatory reform that eventuates will impact the whole of Australia and not only certain states.

The connection with overseas risk management

Meanwhile, we are pleased to report that with the expert contribution of Robert McGowan, we have a seat with the German Federal Institute of Risk Management (BfR).

• They are currently investigating risk management for tattoo inks through expert exchange of data in the field of toxicology between scientists, lawmakers and manufacturers across several European countries, as well as other countries such as Australia and the USA. 

Our Involvement

Our purpose in this involvement is to ensure that Australian regulators have at their disposal international findings when shaping regulations that are based on sound scientific findings.

At this stage, our recommendation to both practitioners and consumers is to ensure that the pigments used meet current European standards.

We will keep you informed of progress as it comes to hand.